presented at the 2006 clear annual conference september 14-16 alexandria, virginia “informal...
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![Page 1: Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia “Informal Complaint Resolution” Irene Clarke, Katja Lutte, Cheryl McDougall](https://reader030.vdocument.in/reader030/viewer/2022032722/56649cdf5503460f949a9167/html5/thumbnails/1.jpg)
Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
“Informal Complaint Resolution”
Irene Clarke, Katja Lutte, Cheryl McDougall
College of Physicians & Surgeons of Ontario
Expect the Unexpected: Are We Clearly Prepared?
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Framework for Resolution
• Backdrop
• Past Processes
• Current Processes
• Case Examples
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Issues Involved in Public Complaint Investigations
5
5
6
16
36
63
65
0 10 20 30 40 50 60 70
Communication issues
Care issues
Conduct and behaviour issues
Records / Report issues
Financial issues
Consent issues
Sexual Abuse
% of time
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Backdrop: Committee Backdrop: Committee DecisionsDecisions
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
2000 2001 2002 2003 2004 2005
No Further Action Caution in Person Referred to QA Referred to Discipline
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Outcomes
Complainant frustration and disbelief
Doctor
stress and annoyance
Complaints Committee $600,000 per year
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Past Resolution Processes
1990-1998Committee Resolution
1997-2001
Informal Staff Resolution
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Committee Resolution(1990 – 1998)
Complaints Committee Directed
Resolution by:Staff facilitatorsExternal mediators
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Committee Resolutions 100 cases
Outcome Agreement – 20% No Agreement – 80%
WhyComplainants
Process starts too late (after 1 year) Process too slow (6-12mo) Lawyer involvement
Physicians Process too slow Mediator: no clinical knowledge
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Informal Staff Resolution1997-2001
Complainants consented to resolution
Via phone or letter Patient Records Written Physician Response Written information
Committee Chair Approval
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Informal Staff Resolutions Results -2001
40% vs. 20% resolve
157 days vs. 547 + days
$500,000 vs $600,000
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Complaints Process Survey2001
Telephone Interviews
Satisfaction Indicators process quality outcome
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Complaints Process Survey 2001
Satisfaction Level Desired Outcome
TimeContinual CommunicationInvestigator with clinical knowledge
Resolution vs. Decision
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Current Process
2001 – present
Proactive Staff Resolution
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Complaints Per Area of Practice
Others(22% )
General Practice(49% )
Psychiatry(6% )
Obstetrics and Gynaecology
(6% )
InternalMedicine
(6% )
Orthopaedic Surgery(4% ) Paediatrics
(2% )
GeneralSurgery(5% )
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Proactive Staff Resolution
Designated Staff
nurses, physiotherapists, social workers
Withsignificant clinical practice background management or teaching experience know health care system
Can communicate
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Investigator on Call
Calls from our general inquiries area
letters
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Investigator on Call2005
366 telephone inquiries forwarded to on-call investigators;
26 converted to complaints.
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Investigator on Call2005
145 letters earmarked for on call resolution
9 converted to formal complaint
(of those 9, 6 were resolved pre-committee review)
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Resolution Criteria
misunderstanding or miscommunication;
a known or common complication of a treatment/procedure;
an isolated incident of less serious conduct unbecoming a physician (i.e. not sexual abuse);
assistance to intervene beyond our jurisdiction;
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Resolution Criteria
isolated incident of minor clinical mishap or oversight;
systems issue;
complainants indicate their wish to resolve;
complainant and respondent have agreed to the resolution process;
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
No Resolution When …
serious concern regarding clinical practice and/or conduct;
the complainant and/or subject physician are not receptive to resolution
the subject physician has a history of complaints pointing to a trend toward conduct or care that was inappropriate;
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
What Investigators Do
Telephone/MeetComplaint as a “whole” Records Provide Context Physician Verbal Response
Joint meeting
Medical Director Approval
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
What They Do
Joint Resolution with Hospitals
MeetComplainantPhysician/sChief of StaffPatient Rep
Records available at meeting
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
What are Key Actions?
Speedy assignment/ and contact Establish rapport with both parties Updates Language Paperless process ‘See’ care in records Collaborate with Chiefs of Staff Systems Approach Appreciation Letter
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
What Makes it Work? Complainant open to explanation Complainant wants ‘error’ fixed Physician open to explaining Physician willing to acknowledge No Lawyers Investigator Flexibility
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
How Did We Do?2004
58% resolved (up from 40%)
62% resolved
65 days (down from 157 days)
$315,000 (down from $500,000)
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Benefits
Support for Process CMPA Chiefs of Staff Hospital Risk Managers/Patient Reps Individual Physicians
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Benefits
Educational Value System Improvements
Increase in satisfaction for all parties, including investigators
Positive College Image
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Benefits
Patient Safety (Lucian Leape, MD)Responding to the patientWhat do patients want? 1. Know what happened (98%)2. Receive an apology3. Be assured the hospital/doctor is doing
all that can be done to prevent a recurrence
**$ is way down the list of patient “wants”
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Benefits
Patient Safety (Leape)The power of silence - destroys the patient’s trust - destroys the physician’s
integrity - “wall of silence” is
devastating for patients
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Fools rush in where angels fear to thread
• Cannot compel physicians to apologize
• Can ask or convey the complainant’s wish for an apology
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Negotiating an Apology
• The complainant request apology and the physician volunteers to apologize
• The complainant wants an apology and the physician needs encouragement
• No request for apology, but one would be the best way to resolve a complaint
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Myth: Apology = Admitting Guilt
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Apology without implied guilt
• I apologize if my behavior…• I apologize for causing you to
believe I was angry• Please forgive me if I offended you,
it was not my intention
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Components of suitable apology letter
• Apologizes/regrets the behavior• Explains what happens• Conveys sincerity by expressing
remorse and displaying empathy• Reflects on the learning
experience• Reiterates regrets and apology
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Apology Busters
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Wrapping it up
• Ask the physician to cc me on letter• One to two weeks after letter sent, I
contact the complainant to discuss• Obtain agreement to close the file• Obtain authorization to close the file
from the medical director• Notify physician and complainant of
closure
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Example # 1
• 28 years of age, TB, previously healthy
• Same Dr. for extended family• Pt so stigmatize, she can’t ever
utter “T.B.” – “ I have a disease”• In following up the contacts, the
secretary confirms the identity of the index case to a family member
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Example # 1 (cont’d)
• The complainant wants the Dr. to be disciplined and to apologize (LOC)
• The Dr. was very stressed about the complaint, wanted to apologize, did not know how to begin
• A sample letter was provided
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Example #2
• 16 year old in ER with back pain, swollen abdomen, urine positive for pregnancy, the nurse hears fetal heart beat, patient never had sexual relations
• Patient told she is pregnant, in denial• Mother not told anything because the
patient is 16• Patient is discharged
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Is “I’m sorry”, an apology?
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Is “I’m sorry”, an apology?
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
QUESTIONS ???
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Presented at the 2006 CLEAR Annual ConferenceSeptember 14-16 Alexandria, Virginia
Speaker Contact Information
Irene Clarke, Katja Lutte, Cheryl McDougall
College of Physicians & Surgeons of Ontario80 College St., Toronto, ON, M5G 2E2
(416) 967-2600 ext: 408; 674; 494 (respectively)
[email protected]@[email protected]
www.cpso.on.ca